Today, I had my port implanted (or as I’ve been mistakenly saying today “installed”. It’s not nearly as fun as having a new kitchen appliance installed in the house 🙂 ). I had been somewhat dreading this procedure because I had read and been told by some of my medical staff that it is a pretty painful procedure, and would probably be another several weeks of recovery, keeping me from the gym, which makes me happy (Feeling a little Elle Woods inspired: “Exercise gives you endorphins. Endorphins make you happy.”).

The port I had implanted is called a Power Port. It is a titanium/silicone device that is a bit bigger than the size of a quarter that is installed under the skin and attached to a catheter that extends into my subclavian vein. It will be used to draw blood and for my chemo infusions. The benefits of the port are that it allows my doctors and staff more control in administering the chemotherapy drugs, prevents damage to the veins by continuously putting in and removing IVs, and prevents burning of the tissue surrounding the site of IVs from the chemotherapy drugs. When I go into receive chemo, a device called a PowerLoc, which is a needle connected to the line going to the infusion bags, will be inserted to the center of the port and lock in place.

My surgeon for this surgery was Dr. Ingram again, who is the one who walked me through the diagnostic phase and did my core and excisional biopsies, so although I didn’t want to have it done, I was very glad that he was doing the surgery. I like him, and I like his demeanor. Everything with him is presented as “This is what it is. This is how I will do it. This is how it will impact your particular lifestyle” (he has taken the time to get to know me well and know my normal habits). He has been practicing medicine for quite some time, is mindful of minimizing scars, and does his best to minimize invasiveness without compromising efficacy.

I had to arrive today about an hour and fifteen minutes prior to my surgery time. This surgery was done at the Moses Cone Surgery Center, which is a facility detached from the main hospital, and was an older facility and lacked some of the niceties that Moses Cone Cancer Center, Moses Cone Radiology Department, and Moses Cone Out-Patient Short Stay Surgical Center had, but they were much more efficient, and didn’t make me arrive the two plus hours early like the others had, so I got to sleep in a bit more and avoid those hours of sitting in the hospital bed hungry and thirsty after being cut off from food and drink at midnight the night before. Upon arrival the nurse who took me back to do the pre-op work-up (all of the standard medical background and lifestyle questions, which I’ve answered multiple times already…) was very sweet and interested in learning of my diagnosis and how I found it and got to this point. Next, I was greeted by Dr. Ingram with a smile who came in and in his normal fashion explained the surgery, risk factors (puncturing of a vein or lung, which Dr. Ingram said is about a 1/100 chance), and recovery time. After Dr. Ingram left, I met with my anesthesiologist Dr. Singer, who also took the time to find out a little bit about me personally and again took a particular interest in my diagnosis. He also addressed the past nausea and vomiting that I had after general anesthesia when I was a child and took preventative measures to add to my anesthesia an anti-nausea cocktail. The last people I met with pre-surgery were my two nurse anesthetists, April and Dennis. April inserted the IV into my hand, and did such a great job that it was almost entirely painless. I only felt the initial sting from the numbing shot and then the initial insertion of the IV. She had it so perfectly in my vein that I didn’t feel or notice it after it was in unless I looked down and saw it. This was the opposite of all of the other IVs I’ve had in recently, which all kind of stung and tugged the entire time they were in my hand/arm. Dennis was very cognizant of the size of my esophagus and determined he would use a smaller tube to try to prevent the throat irritation like I had last time, which lasted for about three days post-surgery. Finally before going back to surgery, Jason was allowed to come back and sit with me. All of my pre-surgery interactions today lowered the anxiety I had been feeling yesterday and early this morning coming into it.

This procedure was done under general anesthesia and took about 45 minutes. April walked me back to the operating room and introduced me to the two nurses who would be on my surgical staff, got me set up on the operating table, and started the anesthesia. After I was out, Dr. Ingram first did a sonogram of my chest to look at the structure of my chest and arteries and veins as to make the procedure go as smoothly as possible. He made two incisions to place the port, both on the right side of my chest between my breast and clavicle. The small incision is about a third of an inch and was used to guide the catheter into my vein and larger incision is about an inch and a half and was used to place Power Port. Dr. Ingram closed the incisions by using dissolvable stitches under the skin, and sealing the incisions with glue, which provides a sterile cover to them and means that I can shower the day after surgery without having to worry about them getting wet and reduces the risk of infection. I regained consciousness about an hour after surgery and felt less groggy this time than after the excisional biopsy, but felt considerably more pain. I ranked my pain at about a 7 (on their 0-10 scale), and was given three infusions of a pain medication that did essentially nothing to reduce the pain. I had two recovery nurses attending to me during the entirety of my time in the recovery room today, which was nice to have that attention and not feel like I was having to flag someone down to tell them that I was in pain or thirsty/hungry. When I first woke up in recovery, a radiology technician used a portable x-ray machine to ensure the port was in place, and that I was stable. After that came back as clear, Jason was allowed to come back and sit with me while I was in the recovery chair for about another 45 minutes. The nurses gave me oxycodone for the pain just prior to me leaving so that I would be able to go home and rest. They also ensured that I had the prescription from Dr. Ingram for a narcotic/acetaminophen for the next couple of days. I like that he focuses on pain management and facilitating efficient recoveries, because I had read other peoples’ accounts of having their ports installed and being given only Tylenol. The oxycodone allowed me to sleep this afternoon, but did not really do much to alleviate the pressure and pain from the newly installed titanium/silicone port and catheter. I finally woke up late this evening to eat my first meal of the day beside the goldfish in the recovery room, text/email with a few friends, and talk to my brother, which provided a distraction to the pain and really cheered me up. The pain levels with this throughout the afternoon and night have continued to stay around a 6, and I have very limited mobility in my right arm, which is the side on which it was placed.

The recovery time from this procedure will be another 2-3 weeks, where I won’t be able to go to the gym or get sweaty or pick anything up for the first week. During the second week, I should be able to return to light exercises (walks) and start to regain my range of motion in my chest, arm, and shoulder. Dr. Ingram said that having the port will likely prevent me from playing tennis while I have it because of the large range of motions when playing that present a large risk of dislocating the port or the dislodging the catheter.

Prior to scheduling the port, I debated the best time to have it done, because I thought I would want it in for the least amount of time. After some consideration, I am glad that I had it installed today and have several weeks prior to starting chemo because it will allow me to recover more fully, and hopefully reduce risks of infection at the incision sites. It will also give me several weeks to recover and become acclimated to it prior to starting chemo and return to more normal activities and maintain my overall health by doing some exercise.

Although I’ve been in pain all afternoon, I have felt more resolute and much calmer, because this is the last necessary procedure to have before starting chemo (outside of the fertility preservation). I know chemo and radiation will be a substantial hurdle, but I am glad I am to the point where that is now a known factor along with the stage and plan. Outside of completing the fertility preservation over the next couple of weeks, the last thing left to decide is whether Dr. Gorsuch or Dr. Park will be my primary oncologist. I meet with Dr. Park tomorrow and hope that Jason and I will have that decision made in the next day or two. And to that point, I have discovered that one of my biggest pet-peeves in dealing with doctors and medical staff is when they do not adjust their demeanor and presentation to fit the patient at hand. I have been fortunate that all but one of my interactions thus far have been great and I felt respected and valued as a patient, which was reiterated by the compassionate care I received today. It only took the one interaction with a nurse who spoke to me as if I were a third grader to put my frustration level through the roof leaving the appointment and to learn what an important factor that is for me when choosing my treatment team. Through conversations with my brother who is graduating med school in a couple of months, I understand that doctors often deal with patients who are uninformed and do not care about their health, but as someone who has always focused on being healthy, and in light of my diagnosis has put in significant research and time to understanding it and my treatment options, and be knowledgeable and well informed and learn and take additional steps to increase my prognosis, I appreciate when my doctors, nurses and medical team recognize my efforts, take the time to get to know me as a person, and are appropriately responsive. I am hopeful that I will have an equally positive interaction with Dr. Park tomorrow as I have with Dr. Gorsuch and will be able to go into some of the deeper considerations of choosing between their respective facilities and resources.

I retire now to a much needed night of sleep and am thankful today for completing the last procedure of a large number of steps in this journey to treatment and remission. Until tomorrow and more decisions…

PS: a picture of the incisions from the port. Some of the coloring at the incisions is from the marker. As a last funny note, I just noticed a small target symbol on the inside of my right boob, which I’m sure had a medical purpose, but at this point provided me with a chuckle, which I have found that laughing through this journey is sometimes the only way to cope (I recognize my humor may be a bit unique at this point 😉 ).